【摘要】 目的 探讨慢性心力衰竭(CHF)患者入院时血清可溶性信号素4D(sSema4D)、热休克蛋白47(HSP47)、网膜素-1(omentin-1)及其联合检测对继发室性心律失常(VA)的早期预测效能。方法 回顾性选取2022年1月至2023年6月郑州大学第一附属医院收治的183例CHF患者，根据心脏再同步化治疗后1年后是否继发VA分为VA组(n=58)和N-VA组(n=125)。比较两组患者的心功能指标[左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期内径(LVEDD)、左心房收缩末期内径(LAD)、心功能分级]、血清sSema4D、HSP47、omentin-1水平；采用Pearson/Spearman相关性检验分析血清sSema4D、HSP47、omentin-1水平与心功能指标的相关性；采用受试者工作特征(ROC)曲线分析血清sSema4D、HSP47、omentin-1水平联合检测对CHF继发VA的早期预测效能。结果 VA组心功能指标LVEF、LVFS分别为(30.12±3.36)%、(24.42±2.27)%，明显低于N-VA组的(32.29±4.24)%、(28.13±3.05)%,LVEDD、LAD、NYHA分级Ⅲ级占比分别为(56.58±4.06) mm、(35.81±3.52) mm、60.34%，明显高于N-VA组的(50.52±3.99) mm、(30.06±2.77) mm、24.80%，差异均有统计学意义(P<0.05);VA组血清sSema4D、HSP47水平分别为(942.92±280.31) pg/mL、(0.40±0.11)μg/L，明显高于N-VA组的(661.11±198.54) pg/mL、(0.26±0.08)μg/L，血清omentin-1水平为(44.36±10.11) ng/L，明显低于N-VA组的(55.12±14.28) ng/L，差异均有统计学意义(P<0.05);Pearson/Spearman相关性分析结果显示，血清sSema4D、HSP47水平与心功能指标LVEF、LVFS呈负相关，与LVEDD、LAD、NYHA分级呈正关性(P<0.05)，而血清omentin-1水平与LVEF、LVFS呈正相关，与LVEDD、LAD、NYHA分级呈负关性(P<0.05)。ROC曲线分析结果显示，血清sSema4D、HSP47、omentin-1水平联合检测预测CHF继发VA的AUC为0.949，高于上述血清指标单独检测。结论 血清sSema4D、HSP47、omentin-1水平与CHF患者心功能指标具有相关性，三者联合检测对CHF继发VA的具有较高的预测效能。更多还原

【Abstract】 Objective To investigate the serum levels of soluble semaphorin 4D(sSema4D), heat shock protein 47(HSP47), and omentin-1 at admission in patients with chronic heart failure(CHF) and the predictive efficacy of their combined detection for secondary ventricular arrhythmias(VA). Methods A retrospective analysis was conducted on 183 CHF patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2022 to June 2023.Based on the occurrence of secondary VA within one year after cardiac resynchronization therapy, patients were divided into a VA group(n=58) and a non-VA(N-VA) group(n=125). Cardiac function indices(left ventricular ejection fraction[LVEF], left ventricular fractional shortening [LVFS], left ventricular end-diastolic diameter [LVEDD], left atrial end-systolic diameter [LAD], and cardiac function classification) and serum levels of sSema4D, HSP47, and omentin-1 were compared between the two groups. Pearson/Spearman correlation analysis was used to assess the relationships between serum sSema4D, HSP47, and omentin-1 levels and cardiac function indices. Receiver operating characteristic(ROC) curve was employed to evaluate the predictive efficacy of combined detection of these serum markers for secondary VA in CHF patients. Results The VA group had significantly lower LVEF and LVFS compared to the N-VA group:(30.12±3.36)% vs(32.29±4.24)%,(24.42±2.27)% vs(28.13±3.05)%, respectively. The VA group also had significantly higher LVEDD, LAD, and proportion of NYHA class Ⅲ compared to the N-VA group:(56.58±4.06) mm vs(50.52±3.99) mm,(35.81±3.52) mm vs(30.06±2.77) mm, 60.34% vs 24.80%, respectively; all P<0.05. Serum s Sema4D and HSP47 levels were significantly higher in the VA group than in the N-VA group:(942.92±280.31) pg/mL vs(661.11±198.54) pg/mL,(0.40±0.11) μg/L vs(0.26±0.08) μg/L; serum omentin-1 level was significantly lower:(44.36±10.11) ng/L vs(55.12±14.28) ng/L; all the differences were statistically significant(P<0.05). Pearson/Spearman correlation analysis showed that serum sSema4D and HSP47 levels were negatively correlated with LVEF and LVFS but positively correlated with LVEDD, LAD, and NYHA classification(P<0.05). In contrast, serum omentin-1 level was positively correlated with LVEF and LVFS but negatively correlated with LVEDD, LAD, and NYHA classification(P<0.05). ROC curve analysis demonstrated that the combined detection of serum sSema4D, HSP47, and omentin-1 levels had an AUC of 0.949 for predicting secondary VA in CHF patients, which was higher than that of any single marker alone. Conclusion Serum levels of sSema4D, HSP47, and omentin-1 are correlated with cardiac function indices in CHF patients. The combined detection of these markers has high predictive efficacy for secondary VA in CHF patients.更多还原